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Laparoscopy or laparotomy for adhesive bowel obstruction in children: a systematic review and meta-analysis

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Abstract

Purpose

Adhesive small bowel obstruction (ASBO) is one of the most important cause of postoperative morbidity in children who underwent abdominal surgery. Laparoscopic management for ASBO in pediatric patients has been reported. However, its safety and efficacy has not been evaluated in details. The aim of this study is to compare the outcomes of laparoscopy and laparotomy for the treatment of ASBO in children.

Methods

A systematic review and meta-analysis were performed following the Cochrane Handbook for systematic reviews of intervention and the preferred reporting item for systematic reviews and meta-analysis (PRISMA) and a protocol registered in PROSPERO (CRD42017067914). The primary outcome was the number of intraoperative and postoperative complications. The secondary outcome was length of hospital stay. The risk of bias in non-randomized studies of interventions (ROBINS-I) tool was used to assess the risk of bias. Quality of evidence was summarized using the grades of recommendation, assessment, development and evaluation (GRADE) approach.

Results

We identified three observational studies and no randomized controlled trials. The meta-analysis was done only for the primary outcome. Complications were significantly fewer after laparoscopy compared to laparotomy (Odds ratio = 0.51; 95% CI 0.40–0.66; p < 0.01; I 2: 0%). The overall risk of bias was considered serious.

Conclusions

Our results, based on observational studies, indicate that laparoscopy for ASBO was associated with less postoperative complications compared to conventional laparotomy. However, the quality of evidence is very low. A well-controlled study is needed to assess the efficacy of laparoscopy for pediatric patients with ASBO.

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Acknowledgements

Dr. Agostino Pierro was supported by the endowment of the Robert M. Filler Chair of Surgery, The Hospital for Sick Children, and by the Canadian Institutes of Health Research (CIHR) Foundation Grant. The authors thank the following individuals who have assisted us with foreign language articles: Dr. Yuriy Kolivoshka (Russian), Dr. Bo Li (Chinese), Ms. Daniela Dominguez (Spanish) and Ms. Alison Hock (French).

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Authors and Affiliations

  1. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Hiromu Miyake, Shogo Seo & Agostino Pierro

  2. Department of Pediatric Surgery, Shizuoka Children’s Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan

    Hiromu Miyake

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  1. Hiromu Miyake
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  2. Shogo Seo
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  3. Agostino Pierro
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Correspondence to Agostino Pierro.

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Miyake, H., Seo, S. & Pierro, A. Laparoscopy or laparotomy for adhesive bowel obstruction in children: a systematic review and meta-analysis. Pediatr Surg Int 34, 177–182 (2018). https://doi.org/10.1007/s00383-017-4186-0

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  • DOI: https://doi.org/10.1007/s00383-017-4186-0

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